STEP 1

1. Lump : benjolan. A piece of solid substance usually with no particular shape
2. Palpitations : denyutan. A condition in which your heart beat too quickly or not
regularly
3. Stool frequency : a seat without any support for the back or arms (stool)
4. Tremor : unintentional trembling or shaking movement in one or more parts of your
body
STEP 2
1. Cause of weight loss
2. Clinical Manifestation
3. What cause a trembling hands
4. What is the patogenesis
5. Why she can’t stand the heat ?
6. How to diagnose for hyperthyroid ?
7. What is the differential diagnose from the scenario ?
8. What are the treatment ?
9. Etiology ?
10. Diagnosis
11. What is biosynthesis of T3 and T4 ?
12. Definition of hyperthyroidism
13. Why the patient have that clinical manifestation ? explain
14. Krisis tiroid ?
15. Explain the hypothyroid
STEP 3
1. What is biosynthesis of T3 and T4 ?
 Phase trapping iodide : bassal cell membranes ability to pump specific
thyroid iodide actively to the inside of the cell ( iodide transport from the
blood into the cells and follicular thyroid glands).
 Oxidation stage : change of iodide ion into the oxide from of iodine, iodine
either early (nascent iodine) which then is able to bind with the amino acid
thyrosine.
This process is enhanced by and accompany peroxidase and hydrogen peroxidase
 Phase organification thyroglobulin the binding of iodine with the
thyroglobuline molecule iodinate thyrosin process sequency :
 Thyrosine diioidnized be monoidothyrosine, then became diiodithyrosine
Occurs chopping of the remaining diiodothyrosine the result of which from the
thyroxine molecule
 Thyroglobulin storage stage : thyroid hormones are stored in the follicle in
sufficient quantities to supply the body with the bodies normal requirements for
thyroid hormone for 2-3 months
 Thyroxine and triiodothyronine release phase of the thyroid gland : thyroglobulin
wasn’t released in the blood, thyroxine and triiodothyronine thyroglobuline be
broken from the free hormone is then release into the blood
2. Cause of weight loss
The occurance because of levels of hypermetabolic inside the body where the tyroid
hormone stimulates lipolysis.
3. Why she can’t stand the heat ?

Because at the time of hormon thyroid increases  activate 1 enzyme (Na+ K+ ATPase) which cause increase Na+ transport forth and K+ through the cell membran.
Because this process requires energy and increase the amount of heat that is formed in
the body which is one cause of the increase body metabolism because at HT
increasedcause increase mitocondrial size and activity leading to increase
metabolism
4. What cause a trembling hands
Increased thyroid hormone increase sensitivity nerve synaps in medulla that
regulate muscle tone.
5. How to diagnose ?
Physical examination revealed
a. High systole blood pressure
b. Hyperactive reflects
c. Increase heart rate
d. Tremor
In the other hand, blood test also done to measure levels of thyroid hormons ex : TSH,
T3 and T4. And it can be this disease may also effect the result of the following test,
ex : glucotest, cholesterol test, radioactive iodine uptake
Test :
a. Serum TSH level where measure by radioimmunometric
b. Uptake of iodine radioisotop to measure the ability of gland
c. Thyroid scan
6. What is the differential diagnose from the scenario ?
a. Euthyroid hyperthyroxinemia Goiter
b. Grave disease
c. Plummer-Vinson syndrome
d. Struma ovarii
e. Tirotoksikosis
7. Diagnosis
Hyperthyroidism
8. Definition of hyperthyroidism
Hyperthyroidism is a condition in which the thyroid gland makes too much thyroid
hormon, the condition is often reffered as an over active thyroid
Hyperthyroidism is a case hypermetabolic that cause increase some endocrine in the
thyroid gland, ex : tiroksin, and triiodotiroksin (T3 and T4)
9. Etiology ?
Graves disease
Tirotoksikosis
Ophtalmophaty infiltrative
Dermophaty Infiltrative
Toxic Multi Nodular Goiter
Solitary toxic adenoma

Hyperthyroidism caused by disfunction of thyroid gland . increased TSH thyroid
gland malfunction to be accompanied by decrease TSH and TRF as a negative
feedback HT on the release of a both
10. What is the pathogenesys
As in autoimmune hyperthyroidism a combination of environmental and genetic
factor including polymorfism in HLA-DR CTLA-4 CD-25 PTTN-22 and TSHR
contribute to briefs disease susceptibility the concordance for Graves disease in
monozygote twins is 20-40% compared to <5% in dizygote twins indirect evidence
suggest stress is an important environmental factor presumably operating throughn
neuroendocrine effects on the immune system.
11. Clinical Manifestation
a. Sudden weight loss
b. Tachycardia/rapid heart beat
c. Increase appetite
d. Tremor
e. Sweating
f. Difficulty sleeping
g. Skin thinning
h. Increase sensitivity to heat
i. Lump in the neck area
12. What are the treatment ?
Hyperthyroidsim is usualy treat with one/more of the following :
a. Anti-thyroid medication (prevent thyroid hormon synthesis : inhibiton of
peroxidase, thereby inhibiting organification)
 Propiltiourasil
 Metimazol
 Carbimazole

b.
c.
d.
e.
f.

Indication : hyperthyroidism
Contraindication : tracheal damage, lactating mothers, hypersensitivity
Radioactive iodine (emission of beta rays will damage the thyroid gland
tissues that hormon production is reduce)
If the patient is >35 years old
Surgery to remove the thyroid
Inhibition anion group ( iodide uptak inhibition mechanism competitively
inhibit iodide transport)
Iodide (organification inhibit iodide and release of T3 and T4 hormon)
Beta blockers, this drugs not for hyperthyroid but for the symptoms
(tachycardia) and help prevent palpitation.

If the thyroid must be removed with surgery or radioactive we must take thyroid hormon
replacement pil for the rest of our live and in the other hand beta blockers such as propanolol
are used to treatment some of the symptomps including rapid heart rate and ancient until the
hyperthyroidism can be controlled.
13. Why the patient have that clinical manifestation ? explain
Palpitation : T3 adn T4 increase metabolism up accelerate oxygen using  increase
releasing the amount of final product from tissue metabolism  catabolism in long

seizeres(kejang). Uncommon medical emergency caused by an exacerbation of hyperthyroidsim characterized of one or more organ system in people with untreated and or poorly treated hyperthyroidism. confussion.time  vasodilatation  increase blood stream  power of cardiac muscle is forced (ditekan)  increase heat rate frequency and kerja jantung meningkat >60% 14. abdominal pain. dehidration. jundice.hyperthyroidism can occur in patient w/ toxic adenoma or multinodular toxic goiter but it’s more often see in grave disease. naussea. comma . Hyperthyroidism crisis classically occurs in patient w/ underlying grave disease or toxic multi nodular goiter often there is sudden onset of sever hyperthyroidism with first hyperpyrexia over 41 celcius. heart rate greater 140/minutes. Hyperthyroid disease crisis usually occur in patient already known to have hyperthyroidism but may be the first presentation of hyperthyroidism early recognition and agressive treatment are essential.

Uptake tsh >>> tsi <<< Clinical manifestation Laboratory checking Treatment .

then became diiodithyrosine Occurs chopping of the remaining diiodothyrosine the result of which from the thyroxine molecule  Thyroglobulin storage stage : thyroid hormones are stored in the follicle in sufficient quantities to supply the body with the bodies normal requirements for thyroid hormone for 2-3 months  Thyroxine and triiodothyronine release phase of the thyroid gland : thyroglobulin wasn’t released in the blood. EGC 3. thyroxine and triiodothyronine thyroglobuline be broken from the free hormone is then release into the blood 2. Edisi 7. PATOLOGI. So the body can not stand the heat. EGC  Mengapa tdk tahan panas ? Karena BMR naik sehingga thermogenesis naik. Why she can’t stand the heat ? Because BMR ride that ride thermogenesis. hangat. Robbins n 'Kumar. PATHOLOGY. Jadi tubuh tidak tahan panas. Vol 2. Karena pada kulit pasien tirotoksikosis cenderung lunak. Cause of weight loss Increased sympathetic activity and hypermetabolism causes weight loss despite increased appetite.  Oxidation stage : change of iodide ion into the oxide from of iodine. What cause a trembling hands . Vol 2. Edisi 7. Robbins n’ Kumar. Edition 7. Vol 2. dan kemerahan. This process is enhanced by and accompany peroxidase and hydrogen peroxidase  Phase organification thyroglobulin the binding of iodine with the thyroglobuline molecule iodinate thyrosin process sequency :  Thyrosine diioidnized be monoidothyrosine. EGC Mengapa bb turun walau nafsu makan bertambah? Peningkatan aktivitas simpatis dan hipermetabolisme menyebabkan penurunan BB walaupun nafsu meningkat. Robbins n’ Kumar. iodine either early (nascent iodine) which then is able to bind with the amino acid thyrosine. EGC 4. What is biosynthesis of T3 and T4 ?  Phase trapping iodide : bassal cell membranes ability to pump specific thyroid iodide actively to the inside of the cell ( iodide transport from the blood into the cells and follicular thyroid glands). pasien sering tidak tahan panas. Edisi 7. Because of the patient's skin tends to soft thyrotoxicosis. Vol 2. Robbins n’ Kumar. patients often do not stand the heat. warm. PATOLOGI. PATOLOGI.STEP 7 1. and redness.

Serum TSH level where measure by radioimmunometric e. which is a typical symptom of hyperthyroidism Due to increased sensitivity of the nerve synapse in the medulla that regulate muscle tone. blood test also done to measure levels of thyroid hormons ex : TSH. Buku Ajar Fisiologi Guyton 5. Buku Ajar Fisiologi Guyton Mengapa tangan gemetar? Peningkatan hormon tiroid juga dapat meningkatkan kontraksi otot yang kuat menimbulkan tremor halus pada otot. Hyperactive reflects g. Struma ovarii j. yang merupakan gejala khas hipertiroidisme Disebabkan bertambahnya kepekaan sinaps syaraf di daerah medulla yg mengatur tonus otot. Grave disease h. cholesterol test. toxic multinodular goiter. Increase heart rate h.Increased thyroid hormone can also increase the strong muscle contractions cause smooth muscle tremor. Diagnosis Hyperthyroidism 8. And it can be this disease may also effect the result of the following test. What is the differential diagnose from the scenario ? f. Definition of hyperthyroidism a. Most common causes of hyperthyroidism are Graves disease. radioactive iodine uptake Test : d. and thyroiditis . ex : glucotest. How to diagnose ? Physical examination revealed e. toxic uninodular goiter. Tirotoksikosis 7. Euthyroid hyperthyroxinemia Goiter g. Tremor In the other hand. Hyperthyroidism refers to conditions caused by excessive thyroid hormone produced by thyroid gland b. Thyroid scan 6. High systole blood pressure f. Uptake of iodine radioisotop to measure the ability of gland f. T3 and T4. Plummer-Vinson syndrome i.

and iodine ingestion d. This disease can be fatal and can occur in infants whose mothers suffer or have ever suffered from Graves' disease. which serves to inhibit the formation of thyroid hormones. the newborn.High blood pressure . but the baby still has a risk of recurrence for 6 months to 1 year.Diarrhea.COM Hipertiroidisme Hipertiroidisme terjadi karena kelenjar tiroid yang terlalu aktif. WWW. pituitary resistance to thyroid hormone. the symptoms of an overactive thyroid gland can occur within a few days after birth: . Less common causes of hyperthyroidism are thyroid-stimulating hormone (TSH)producing tumors. As with adults. miscarriage or premature birth. In pregnant women. Overt hyperthyroidism is defined as low serum TSH with elevated peripheral thyroid hormone values (free T3 and/or free T4). May also need treatment for heart failure.html Hyperthyroidism occurs due to an overactive thyroid gland. the recovery will happen in a few weeks. If the treatment is done.Do not gain weight . it may be necessary to replace blood transfusions (number of infant blood removed and replaced with blood from a donor).vomiting . while subclinical hyperthyroidism is defined as low serum TSH with normal peripheral thyroid hormone values https://www.com/topics/endocrinology/hyperthyroidism. trophoblastic disease. the cause of hyperthyroidism is the most common neonatal Graves disease. these antibodies can be up to stimulate the fetus and the fetal thyroid gland.c. mental retardation. High levels of thyroid hormone can cause rapid heart rate which in turn can lead to heart failure. Pada bayi baru lahir.MEDICASTORE. penyebab dari hipertiroidisme yang paling sering ditemukan .Rapid heartbeat . Graves' disease in the mother can lead to stillbirth. In newborns. hyperactivity in childhood and slow growth. Hyperthyroidism treated with propylthiouracil medicine. If the levels of TSH (thyroid-stimulating hormone) is very high. the eyes also stand out.clinicalkey. Thyroid stimulating antibody levels remained high can also cause premature closure of the fontanel. In newborns.Fussy or restless . Signs and symptoms generally result from stimulation of adrenergic nervous system e. Mumps can suppress airway and interfere with breathing. Graves' disease is an autoimmune disease in which the body produces antibodies that stimulate the thyroid gland.

denyut jantung yang cepat .berat badan tidak bertambah . while Type II is type of thyroiditis . antibodi ini bisa sampai ke janin dan merangsang kelenjar tiroid janin. Jika dilakukan pengobatan.muntah . causing a transient thyrotoxic state f. Gondok bisa menekan saluran udara dan mengganggu proses bernafas. mungkin perlu dilakukan transfusi darah ganti (sejumlah darah bayi dibuang dan diganti dengan darah dari donor). causing transient thyrotoxic state and thyroid pain e. Penyakit ini bisa berakibat fatal dan bisa terjadi pada bayi yang ibunya menderita atau pernah menderita penyakit Graves.tekanan darah tinggi . Toxic uninodular goiter (adenoma): solitary nodule in thyroid gland overproducing thyroid hormone independently of TSH d.COM 9. stored thyroid hormones are released into circulation. also known as thyroid-stimulating immunoglobulin b. Etiology ? a. Hipertiroidisme diobati dengan obat propilthiouracyl. Consequently. Penyakit Graves adalah suatu penyakit autoimun dimana tubuh menghasilkan antibodi yang merangsang kelenjar tiroid. keterbelakangan mental. WWW. Toxic diffuse goiter or Graves disease (most common cause): an autoimmune disease in which thyroid gland is being stimulated by thyrotropin receptor antibodies. keguguran atau kelahiran prematur. Pada bayi baru lahir. hiperaktivitas pada masa kanakkanak dan pertumbuhan yang lambat. yang berfungsi menghambat pembentukan hormon tiroid. gejala kelenjar tiroid yang terlalu aktif bisa timbul dalam waktu beberapa hari setelah lahir: . pada bayi baru lahir. Subacute thyroiditis: usually idiopathic but sometimes can be result of virally mediated inflammation and destruction of thyroid gland. Jika kadar TSH (thyroid-stimulating hormone) sangat tinggi.MEDICASTORE.diare. mata juga menonjol. in which stored thyroid hormones are released into circulation. Kadar hormon tiroid yang tinggi bisa menyebabkan denyut jantung menjadi cepat yang selanjutnya dapat menyebabkan gagal jantung. Pada wanita hamil.adalah penyakit Graves neonatorum. Toxic multinodular goiter: multiple areas in thyroid gland overproduce thyroid hormone independently of TSH c.rewel atau gelisah . Penyakit Graves pada ibu bisa menyebabkan lahir mati. Mungkin juga perlu dilakukan pengobatan terhadap gagal jantung. pemulihan akan terjadi dalam beberapa minggu. Postpartum or sporadic thyroiditis: painless autoimmune inflammation of thyroid gland. tetapi bayi tetap memiliki resiko kekambuhan selama 6 bulan sampai 1 tahun. Seperti halnya pada dewasa. Kadar antibodi perangsang tiroid yang tetap tinggi juga dapat menyebabkan penutupan dini ubun-ubun. Amiodarone-induced (types I and II): Type I is iodine-induced.

even in very large doses. 1935). A characteristic feature. Smith and Smith and others in the early 1920s led to the claim of experimental production of exophthalmos and hyperthyroidism in the rat by pituitary extracts (Marine & Rosen. 1955). . recognized after 1950. The demonstration by Cannon of the physiological effects of adrenaline led to the postulate of a mechanism via the sympathetic nervous system. Various views have been held in the past depending on successive advances in physiology and biochemistry. The high effectiveness of therapy for thyrotoxicosis based on partial ablation of the thyroid gland contrasts strikingly with the tendency to recurrence of hyperadrenalism following partial ablation of hyperplastic adrenal glands. What is the pathogenesys The pathogenesis of hyperthyroidism The major question to be solved in the pathogenesis of hyperthyroidism is the mechanism responsible for oversecretion by the thyroid gland.clinicalkey.g. or thyroiditis due to various causes (Liddle. 1934).com/topics/endocrinology/hyperthyroidism. this observation was in keeping with the suggestion that the disorder resided within the thyroid itself. The recognition of pituitary thyroid control and preparation of potent pituitary extracts by Evans. Iatrogenic or factitious thyrotoxicosis: due to intentional or inadvertent ingestion of exogenous thyroid hormone https://www. The demonstration that iodine was a component of the thyroid gland by Baumann in 1895 led eventually to the postulate that the disorder was essentially one of iodine metabolism. Where it is not the gland is hypersecreting from a small pool of hormone due to previous surgery. This property suggested to Werner (1955) that the thyroid gland itself was at fault and not the pituitary trophic hormone secretion.html 10. Charcot (1856) regarded the condition as a neurosis until Moebius pointed out the associated goitre. While this property is not always associated with elevated levels of circulating thyroid hormones it usually is. These findings led to the postulate of hyperpituitarism as the mechanism of the disorder (Marine. Heyssel & McKenzie. is that the hypersecreting gland is not suppressed by the administration of thyroxine or triiodothyronine. 1965). in contrast to the normal gland (Werner.

owing to increased awareness and improved biochemical testing. flushing of the face and upper trunk. fast or irregular heart beat.pdf 12. Nowadays patients often are diagnosed at an early stage of disease. fast tendon reflexes.pdf 11.full. Betablockers should not be taken if the patient has asthma or a wheezy chest. none of the symptoms or signs just listed is sufficiently sensitive or specific for the diagnosis of hyperthyroidism. This and other similar postulates raises the question of the nature of thyroid secretion in thyrotoxicosis. Signs include shaky and hot hands. because of the associated weight loss. http://www. weight loss despite good appetite. They have no effect on curing the thyroid overactivity. inappropriate anxiety. What are the treatment ?  Betablockers Betablockers are a group of drugs that tend to improve some of the symptoms and manifestations of hyperthyroidism. during this time the person can feel very unwell. Thus.british-thyroid-association. inability to sit still. heat intolerance. http://pmj. they can improve palpitations. whereas children tend to hyperactivity. breathlessness and ankle swelling. Therefore some patients have relatively few of the classical signs or symptoms. an enlarged thyroid gland and prominent or bulging eyes. 1937). Clinical Manifestation Common complaints include fatigue. It is not uncommon for people to worry that they have cancer.  Antithyroid drugs Carbimazole (Neomercazole) and propylthiouracil are antithyroid drugs that are effective in . nausea and increased frequency of defecation. but do make many people feel better.Plummer had originally suggested that exophalmic goitre patients were suffering from 'dysthyroidism' or an abnormal thyroid secretion (Means. In addition. sweating. shortness of breath. palpitations of the heart. with a short attention span.com/content/44/511/363. poor sleep. even when combined together. thirst. slow the heart down and improve tremor. it may take three to six months to diagnose hyperthyroidism. shakiness. The elderly may complain predominantly of heart problems with a fast or irregular heart beat.org/info-forpatients/Docs/bta_patient_hyperthyroidism. tetchiness and agitation. In particular.bmj.

Patients with ophthalmopathy require careful evaluation. Patients with Graves’ disease have a high rate of permanent thyroid underactivity following radioiodine (about 80%). A more permanent solution is often sought. with only around half eventually becoming underactive. Both drugs have the common side effects of rash and joint pains. Lancet 1999. The dosage of these antithyroid drugs can either be adjusted every 6 to 8 weeks according to thyroid hormone levels in the blood. should this develop.  Radioiodine Radioiodine is a radioactive isotope of iodine ( 131I) that is taken up and concentrated selectively by the thyroid gland. and more rarely (less than 1 in 500 cases) a serious reduction in the circulating white blood cells (agranulocytosis) may occur during treatment. Patients are monitored for underactivity following the dose and promptly treated with thyroxine. called a definitive treatment. once the drug is stopped. In people with Graves’ disease. higher dose and levothyroxine replacement added to maintain normal thyroid hormone levels (block and replace regimen). as radioiodine may worsenthyroid eye disease: this can be prevented by a short course of steroid tablets. with no overall excess of cancers in many hundreds of thousands of patient years of follow up (JAMA 1998. 280: 347-355. just a temporary reduction in thyroid hormone levels. In most people. over 6 weeks to 6 months following a single dose. The common outcome of thyroid underactivity is an accepted consequence of radioiodine therapy because hyperthyroidism is a serious condition whereas replacement treatment with levothyroxine is simple and has no side effects at the correct dose. In nodular hyperthyroidism (solitary toxic nodule or toxic multinodular goitre).reducing the production of thyroid hormones in the majority of people with hyperthyroidism. There is no . Radioiodine is a safe treatment for thyroid overactivity. treatment with one of these drugs for between 6 months and 2 years results in a long-term remission in around half of patients. this small dose of radioactivity is sufficient to gradually destroy the thyroid tissue. whereas patients with nodular thyroid overactivity tend to preserve their thyroid function better. antithyroid drugs do not result in cure. to keep the person’s thyroid hormone levels in the normal range (titrated dose regimen) or kept at a fixed. 353: 2111-5).

as the baby’s thyroid could be damaged. the TSH is suppressed but the free thyroid hormone levels are normal. if causing severe symptoms. other precautions are necessary to minimise radiation exposure of others but these restrictions are usually easily accommodated by the patient. with a low risk of complications.damage to fertility or to hair growth.  Thyroid surgery Surgery to remove most or all of the thyroid gland (subtotal or total thyroidectomy) is another way of definitively treating thyroid overactivity. Men should avoid fathering a child within 4 months of treatment. Thyroidectomy is a good treatment option for people with a large goitre and for those with thyroid eye disease. However. This is a straightforward operation when carried out by an experienced thyroid surgeon. Radioiodine may trigger airport security alarms up to eight weeks following a dose and patients should carry a letter about the treatment if they travel in this period. Hypothyroidism is a recognised side effect of surgery for which levothyroxine replacement will be needed. Prior to thyroid surgery.000 doses annually are given in the UK. but women are advised not to become pregnant for 6 months following a dose. meaning that the overactivity recovers spontaneously and no treatment may be required. Radioiodine is the most cost effective and certain treatment for thyroid overactivity and about 10. Endocrinologists regard this condition as a precursor of overt or clinical hyperthyroidism but there is some debate over whether this mildest of degree of hyperthyroidism should be treated . Furthermore. If the person has severe symptoms of thyrotoxicosis. usually with antithyroid drugs to make an anaesthetic safe. in some cases thyroiditis can be painful or prolonged and antiinflammatory tablets or steroids may be helpful. Treatment of thyroiditis Many forms of thyroiditis are ‘self-limiting’. betablockers are helpful. Following a standard dose of radioiodine. thyroid overactivity needs to be controlled. and this may require levothyroxine treatment. lifelong. Subclinical hyperthyroidism In subclinical hyperthyroidism. This is because an anaesthetic in a hyperthyroid person has a high risk of precipitating a dangerous hyperthyroid crisis or “thyrotoxic storm”. in some cases a period of thyroid underactivity may follow the thyrotoxicosis.

org/info-forpatients/Docs/bta_patient_hyperthyroidism. cardiac output. dan Volume darah meningkat karena meningkatnya metabolism dalam jaringan mempercepat pemakaian oksigen dan memperbanyak produk akhir yang dilepas dari jaringan. 291: 228-238. -FISIOLOGI KEDOKTERAN. Why the patient have that clinical manifestation ? explain  Palpitation: blood flow. although there is a consensus that treatment may be worthwhile in the elderly. Efek ini menyebabkan vasodilatasi pada sebagian besar jaringan tubuh. a typical symptom of severe somnolence hypothyroidism.). cardiac deny frequency.(JAMA 2004.  Palpitation : Aliran darah. Guyton Efek kronotropik dan Inotropik terhadap jantung yaitu menambah kekuatan kontraksi otot dan menambah irama jantung. timbul kesulitan tidur. Sebaliknya. but because of the effects of thyroid hormone on the excitation of the synapse. This effect causes vasodilation in most tissues of the body. particularly if the heart rhythm becomes abnormal or there is thinning of the bones or low-impact bone fractures.pdf 13. http://www. and volume of blood increases due to increased metabolism in tissue oxygen consumption and increase speed up the final product is released from the tissue. Fisiologi Guyton Chronotropic and inotropic effects on the heart that is adding increase the force of muscle contraction and heart rhythm. thus increasing blood flow. maka pasien hipertiroid sering merasa lelah terus menerus. 2007 . Further research is being conducted in this area. . Guyton Sukar tidur: Efek pada tidur Oleh karena efek yang melelahkan dari hormone tiroid pada otot dan system saraf pusat.british-thyroid-association. sehingga meningkatkan aliran darah.  It is difficult to sleep: Effects on sleep o Because of the exhausting effects of thyroid hormone on muscle and central nervous system. disertai dengan waktu tidur yang berlangsung selama 12-14 jam sehari. In contrast. At present treatment is a matter for individual clinical evaluation and discussion between patient and doctor. tetapi karena efek eksitasi dari hormone tiroid pada sinaps. Frekuensi deny jantung. J Clin Endocrinol Metab. somnolen berat merupakan gejala khas hipotiroidisme. the hyperthyroid patients often feel tired constantly.92:3-9. accompanied by bedtime that lasts for 12-14 hours a day. Curah jantung. sleep difficulties arise.

Edition 7. PATOLOGI. Robbins n’ Kumar. Edisi 7. pasien sering tidak tahan panas. Because of the patient's skin tends to soft thyrotoxicosis. Robbins n 'Kumar. Buku Ajar Fisiologi Guyton  Mengapa capai? Karena efek yg melelahkan dari hormone tiroid pada otot dan system syaraf pusat maka pasien dengan hiper tiroid merasa lelah terus menerus.-FISIOLOGI KEDOKTERAN. and redness. patients often do not stand the heat. paranoia  always restless and sweating Guyton Textbook of Physiology  Mengapa banyak keringat? Berhubungan dengan sistem saraf pusat (menimbulkan disosiasi pikiran)  cemas dan psikoneurotik. Guyton Why succumb hot? Because BMR ride that ride thermogenesis. hangat. Vol 2. dan kemerahan. PATHOLOGY. Karena pada kulit pasien tirotoksikosis cenderung lunak. EGC  Why do a lot of sweat? Associated with central nervous system (causing the dissociation of mind)  anxiety and psychoneurotic. warm. paranoia  selalu gelisah dan berkeringat Buku Ajar Fisiologi Guyton  Why accomplish? Because the debilitating effects of thyroid hormone on the muscle and the central nervous system of patients with hyper thyroid feel tired continuously. EGC  Mengapa tdk tahan panas ? Karena BMR naik sehingga thermogenesis naik. So the body can not stand the heat. Jadi tubuh tidak tahan panas. Buku Ajar Fisiologi Guyton  Why is it weak? . Vol 2.

Buku Ajar Fisiologi Guyton  Mengapa tangan gemetar? Peningkatan hormon tiroid juga dapat meningkatkan kontraksi otot yang kuat menimbulkan tremor halus pada otot. Buku Ajar Fisiologi Guyton  Mengapa lemah? Otot otot pada penderita hipertiroid akan menjadi lemah dikarenakan adanya proses katabolisme protein yg berlebihan. PATHOLOGY. Robbins n 'Kumar. Buku Ajar Fisiologi Guyton  Why shaking hands? Increased thyroid hormone can also increase the strong muscle contractions cause smooth muscle tremor. Robbins n’ Kumar. PATOLOGI. Vol 2. Vol 2. Edition 7. yang merupakan gejala khas hipertiroidisme Disebabkan bertambahnya kepekaan sinaps syaraf di daerah medulla yg mengatur tonus otot. Edisi 7.Muscles in patients with hyperthyroidism will be weakened due to protein catabolism superfluous. EGC  Mengapa bb turun walau nafsu makan bertambah? Peningkatan aktivitas simpatis dan hipermetabolisme menyebabkan penurunan BB walaupun nafsu meningkat. which is a typical symptom of hyperthyroidism Due to increased sensitivity of the nerve synapse in the medulla that regulate muscle tone. EGC  Mengapa sering BAB? . Buku Ajar Fisiologi Guyton  Why weight loss but increased appetite? Increased sympathetic activity and hypermetabolism causes weight loss despite increased appetite.

yang dapat menimbuklan peningkatan motilitas dan diare pada hipertiroidisme dan memperlambat transit usus serta konstipasi pada hipotiroidisme. sehingga sering terjadi diare  Mengapa sesak nafas bila kerja fisik? . Pada saluran cerna. Hal ini juga menyumbang pada timbulnya penurunan berat badan yang sedang pada hipertiroidisme dan pertambahan berat pada hipotiroidisme.Efek Gastrointestinal Hormon tiroid merangsang motilitas usus. hormone tiroid yang meningatkat dapat mempercepat sekresi getah pencernaan dan pergerakan saluran cerna. selain dapat meningkatkan nafsu makan dan asupan makanan.

.

Hyperthyroidism crisis classically occurs in patient w/ underlying grave disease or toxic multi nodular goiter often there is sudden onset of sever .14. Uncommon medical emergency caused by an exacerbation of hyperthyroidsim characterized of one or more organ system in people with untreated and or poorly treated hyperthyroidism.hyperthyroidism can occur in patient w/ toxic adenoma or multinodular toxic goiter but it’s more often see in grave disease. Hyperthyroid disease crisis usually occur in patient already known to have hyperthyroidism but may be the first presentation of hyperthyroidism early recognition and agressive treatment are essential.

pulmonary thromboembolism. Definisi Krisis tiroid merupakan suatu keadaan klinis hipertiroidisme yang paling berat mengancam jiwa. or hypothalamus. hypoglycemia. B. The main cause of a. palpas tiroid terlalu kuat. dan berhubungan dengan faktor pencetus : infeksi. and is associated with precipitating factors: infection. emotional stress. this generally occurs in patients with Graves' disease foundation or toxic multinodular goitre. Thyroid crisis due to malfunctions hipofisi gives an overview of HT and TSH levels are high. comma 15. hipoglikemia. 1. tromboemboli paru. trauma. confussion. umumnya ini timbul pada pasien dengan dasar penyakit Graves atau Struma multinodular toksik. pituitary cancer . cessation of anti-thyroid drugs. naussea. etiology Thyroid crisis can occur due to dysfunction of the thyroid gland. parturition. partus. jundice. TRF will be low because of negative feedback from HT and TSH. A. Thyroid crisis due to malfunctioning hypothalamus will show a high HT accompanied by excessive TSH and TRH. Krisis tiroid ? A. penghentian obat anti tiroid. Excessive iodine consumption e. trauma. operasi. Excessive intake of thyroid hormone d. cerebrovascular disease / stroke. "Solitary toxic adenoma" 2. surgery. Toxic multinodular c. abdominal pain. increased TSH thyroid gland malfunctions due to be accompanied by decreased TSH and TRF as a negative feedback on the release of both HT.hyperthyroidism with first hyperpyrexia over 41 celcius. seizeres(kejang). definition Thyroid crisis is a situation most severe clinical hyperthyroidism life-threatening. the pituitary. troboblastis disease c. ketoacidosis. zat kontras beriodium. stress emosi. heart rate greater 140/minutes. substance iodized contrast. thyroiditis b. ketoasidosis. penyakit serebrovaskuler/strok. Grave's disease b. dehidration. thyroid palpas too strong. other causes a.

atau hipotalamus. Krisis tiroid akibat malfungsi hipofisi memberikan gambaran kadar HT dan TSH yang tinggi. Drugs such as amiodarone B. hipofisis. 1 2 Penyebab utama a Penyakit Grave b Toxic multinodular c “Solitary toxic adenoma” Penyebab lain a Tiroiditis b Penyakit troboblastis c Ambilan hormon tiroid secara berlebihan d Pemakaian yodium yang berlebihan e Kanker pituitari f Obat­obatan seperti Amiodarone . peningkatan TSH akibat malfungsi kelenjar tiroid akan disertai penurunan TSH dan TRF karena umpan balik negatif HT terhadap pelepasan keduanya.f. Krisis tiroid akibat malfungsi hipotalamus akan memperlihatkan HT yang tinggi disertai TSH dan TRH yang berlebihan. TRF akan rendah karena umpan balik negatif dari HT dan TSH. Etiologi Krisis tiroid dapat terjadi akibat disfungsi kelenjar tiroid.

Patofisiologi G3 organik kelenjar tiroid G3 Fungsi Hipotalamus /hipofisi Produksi TSH meningkat Produksi hormone tiroid meningkat Proses glikogenesis meningkat Metabolisme tubuh meningkat Produksi kalor meningkat Proses pembakaran lemak meningkat Aktifitas GI meningkat Peningkatan suhu tubuh Suplai nutrisi yang tidak adekuat Nafsu makan meningkat Penurunan berat badan G3 rasa nyaman panas G3 body image Perubahan pola kerja jantung dan paru G3 pola kognitif Ketidakstabilan emosi Perubahan pola nutrisi .

Can not stand the heat 9.   iritabilitas.   peningkatan   kepekaan   terhadap katekolamin 3 Peningkatan   laju   metabolisme   basal.   peningkatan   pembentukan   panas. Bulging eyes (exoptalmus) Manifestasi klinis 1 Peningkatan frekuensi denyut jantung 2 Peningkatan   tonus   otot. increased sensitivity to catecholamines 3. keringat berlebihan 4 Penurunan berat. increased hunger (good appetite) 5. Increased muscle tone.   tremor. Increased heart rate 2. irritability. heat intolerance. Increase in basal metabolic rate. excessive sweating 4. rapid fatigue 10. reproductive disorders 8. Increased frequency of bowel movements 6. tremor. Weight loss. sign bruit 11. Menstruation bit and not fixed 12.   intoleran terhadap panas. increased heat generation. which increased the size of the thyroid gland 7. peningkatan rasa lapar (nafsu makan baik) 5 Peningkatan frekuensi buang air besar 6 Gondok (biasanya). Enlargement of the thyroid gland 13. yaitu peningkatan ukuran kelenjar tiroid 7 Gangguan reproduksi 8 Tidak tahan panas 9 Cepat letih 10 Tanda bruit . Goiter (usually).Clinical manifestations 1.

 Free T3 (triiodothyronine) 4. TSH (Thyroid Stimulating Hormone) 2. TSH. dan TRH akan memastikan diagnosis   keadaan   dan   lokalisasi   masalah   di   tingkat susunan saraf pusat atau kelenjar tiroid. yang dapat  menyebabkan hiperglikemia Complication . 1. Thyroid scan to see an enlarged thyroid gland 6. 1 TSH(Tiroid Stimulating Hormone) 2 Bebas T4 (tiroksin) 3 Bebas T3 (triiodotironin) 4 Diagnosa juga boleh dibuat menggunakan ultrabunyi untuk memastikan pembesaran  kelenjar tiroid 5 Tiroid scan untuk melihat pembesaran kelenjar tiroid 6 Hipertiroidisme dapat penurunan kadar lemak 7 disertai  serum Penurunan kepekaan terhadap insulin. which can cause hyperglycemia Pemeriksaan Diagnostik Diagnosa bergantung kepada beberapa hormon berikut ini : Pemeriksaan darah yang mengukur kadar HT (T3 dan T4).11 Haid sedikit dan tidak tetap 12 Pembesaran kelenjar tiroid 13 Mata melotot (exoptalmus) Diagnostic examination Diagnosis depends on several hormones following: Blood tests that measure levels of HT (T3 and T4). and TRH will confirm the diagnosis and localization problems at the state level or central nervous system thyroid gland. Hyperthyroidism can be accompanied by decreased serum lipid levels 7. Diagnosis may also be made using ultrabunyi to ensure the enlargement of the thyroid gland 5. TSH. Decrease in sensitivity to insulin. Free T4 (thyroxine) 3.

 dermopati Graves. Akibatnya adalah pelepasan HT dalam jumlah yang sangat besar yang menyebabkan   takikardia. It can berkernbang spontaneously hyperthyroid  patients who underwent therapy.Complications of thyroid crisis can be life threatening is thyrotoxic  crisis (thyroid storm). dermopati  Graves. conservative Governance Graves disease a. The result is the release of HT in very large numbers that cause tachycardia.Contoh are as follows: 1) Thioamide 2) Methimazole initial dose of 20 -30 mg / day . Anti-thyroid drugs. Krisis tiroid : mortalitas Management 1. Thyroid crisis: mortality Komplikasi Komplikasi   Krisis   tiroid   yang   dapat   mengancam   nyawa   adalah   krisis   tirotoksik (thyroid   storm). infeksi karena agranulositosis pada pengobatan dengan obat antitiroid.   dan. kematian. selama pembedahan kelenjar tiroid.  tremors. in the treatment of infections due to agranulocytosis with  antithyroid drugs. Graves oftalmopati.   hipertermia   (sampai   106°F).   apabila   tidak diobati.   Hal   ini   dapat   berkernbang   secara   spontan   pada   pasien   hipertiroid   yang menjalani terapi. Penyakit jantung Hipertiroid. surgery for thyroid gland. This drug inhibits the production of thyroid hormones. hyperthermia (up to 106 ° F). atau terjadi pada pasien hipertiroid yang tidak terdiagnosis. Heart disease Hyperthyroidism. death. patients experience symptoms of drug hipotiroidisme. If excessive doses. if untreated. agitation. or  hyperthyroidism occur in patients who are not diagnosed.   agitasi. and.   tremor. oftalmopati Graves.

000  mg/hari b 4 Potassium Iodide 5 Sodium Ipodate 6 Anion Inhibitor Beta­adrenergic   reseptor   antagonist. Beta-adrenergic receptor antagonist. This action is to destroy the thyroid gland is hyperactive b. Thyroidectomy.000 mg / day 4) Potassium Iodide 5) Sodium Ipodate 6) Anion Inhibitors b.   Jika   dosis berlebih.   pasien   mengalami   gejala   hipotiroidisme. dosis maksimal 2.   Obat   ini   menghambat   produksi   hormon   tiroid.3) Propylthiouracil (PTU) initial dose of 300-600 mg / day.Contoh   obat   adalah   sebagai berikut : 1 Thioamide 2 Methimazole dosis awal 20 ­30 mg/hari 3 Propylthiouracil (PTU) dosis awal 300 – 600 mg/hari.   Obat   ini   adalah   untuk   mengurangi   gejala­ gejala hipotiroidisme. Radioactive iodine. Surgical a. Surgery action is to remove the thyroid gland is enlarged Penatalaksanaan 1 Konservatif Tata laksana penyakit Graves a Obat   Anti­Tiroid. Example: Propranolol 2. . Contoh: Propanolol 2 Surgical a Radioaktif iodine. This medication is to reduce the symptoms of hypothyroidism. the maximum dose of 2.

. dengan akibat terjadinya defisiensi hormon tiroid. Jakarta 4 Doenges. (Edisi 2). Moorhouse. Hipotiroid adalah suatu penyakit yang disebabkan oleh gangguan pada salah satu tingkat dari aksis hipotalamus-hipofisis-tiroid-”end organ”. Patologi. EGC. Volume 2. (Edisi 8). or impaired tissue response to thyroid hormone. Jakarta. Elizabeth. Rencana Asuhan Keperawatan. Congenital hypothyroidism. hypothyroidism in children can be divided into two: 1. Jakarta.Anterior pituitary synthesize thyrotropin ("TSH = thyroid stimulating hormone") which stimulates the thyroid gland. 2 Carpenito. FKUI. Explain the hypothyroid Hypothyroidism is a disease caused by a disturbance in one of the levels of the hypothalamicpituitary-thyroid-"end organ". hipotiroid pada anak dibedakan menjadi 2 : 1. Jakarta 16. Jakarta 3 Corwin. Marilynn dan MF. 1999. Patofisiologi. EGC. Acquired hypothyroidism. 2.Tindakan ini adalah untuk memusnahkan kelenjar tiroid yang hiperaktif b Tiroidektomi.The thyroid gland to synthesize thyroid hormone ("triiodothyronin = T3 = T4 = tetraiodothyronin and thyroxin") which stimulates metabolism network includes: oxygen . . 2. Hipotiroid kongenital. (Edisi III). 1979. Rencana Asuhan dan Dokumentasi Keperawatan. According onset. 5 FKUI. Menurut onsetnya. Synthesis of thyroid hormones is regulated as follows: . Pathophysiology Hypothyroidism can be caused by disruption of thyroid hormone synthesis or disruption of tissue response to thyroid hormone. . 2001. J. 2002. ataupun gangguan respon jaringan terhadap hormon tiroid. EGC. E.  Tindakan   Pembedahan ini   untuk mengangkat   kelenjar tiroid yang membesar Sumber: 1 Bare & Suzanne. EGC. Hipotiroid dapatan. Buku Ajar Keperawatan Medikal Bedah. 2001. with the result of thyroid hormone deficiency.The hypothalamus makes "thyrotropin releasing hormone (TRH)" which stimulates the anterior pituitary.

.With or without goiter goiter.Hipotalamus membuat ”thyrotropin releasing hormone (TRH)” yang merangsang hipofisis anterior. body heat production. nerve function. . and "motling" (Stained-spotting).Rectal temperature <35. . o Dishormonogenesis.The causes of acquired ("acquired"): . Clinical Symptoms History and symptoms in neonates and infants: .consumption.Fontanella major wide open posterior fontanel. cold. especially when onset occurs before the age of 3 years. o Be temporary:  Induction drugs. The causes of hypothyroidism: .It is difficult to drink. .Bradycardia (<100/minute). .Kelenjar tiroid mensintesis hormone tiroid (”triiodothyronin = T3 dan tetraiodothyronin = T4 = thyroxin”) yang merangsang metabolisme jaringan yang meliputi : konsumsi oksigen. Early diagnosis and treatment is important to prevent permanent mental patients. . .Makroglosi.Lethargy. .Hipofisis anterior mensintesis thyrotropin (”thyroid stimulating hormone = TSH”) yang merangsang kelenjar tiroid.History of jaundice more than 3 days. produksi panas tubuh. PATOFISIOLOGI Hipotiroid dapat disebabkan oleh gangguan sintesis hormon tiroid atau gangguan pada respon jaringan terhadap hormon tiroid. . slow. .Dry skin.The causes of congenital (congenital): o Disgenetik thyroid gland: ectopic. agenesis. lemak.Permanent disturbance of mental development. metabolisme protrein. . . Sintesis hormon tiroid diatur sebagai berikut : .First Chapter History> 20 hours after birth and constipation (<1 time / day). dan vitamin-vitamin. fats. as well as work than other hormones. .Birth weight> 3500 g. .Big and husky voice.Miksedema.Dry skin.  Idiopathic. .Intolerance to cold. or hipoplasi aplasi. mental. teeth. carbohydrates. . .Impaired growth (dwarf). gestation> 40 weeks. o 'the hypothalamic-pituitary hypothyroidism'. .Miksedema.Low blood pressure. serta kerja daripada hormonhormon lain.  maternal antibodies. .Impaired motor development.5 ˚ C within 0-45 hours after birth. metabolism protrein. Symptoms in older children: . .  Treatment of radio-active iodine. . low metabolism. o Mother gets  Material goitrogen. fungsi syaraf. bones. . karbohidrat. and puberty.Reduced activity. and vitamins. .Umbilical hernia.

Dengan goiter maupun tanpa goiter.  Idiopatik. lambat. o ’Hypothalamic-pituitary hypothyroidism’. dsb). mental.Fontanella mayor yang lebar dan fontanella posterior yang terbuka. .  Antibodi maternal.Miksedema. o Bahan-bahan goitrogen (yodium.Suara besar dan parau.Hernia umbilikalis. . . etc. . .Ganguan perkembangan mental permanen terutama bila onset terjadi sebelum umur 3 tahun. "euthyroid sick syndrome". .Gangguan pertumbuhan (kerdil). gigi. dingin. . . Thyroidectomy.5˚C dalam 0-45 jam pasca lahir. o Bersifat sementara :  Induksi obat-obatan. . iodine deficiency (endemic goiter).Berat badan lahir > 3500 gram.Gangguan perkembangan motorik. .Miksedema. .o o o o o o o chronic lymphocytic thyroiditis.Sebab-sebab bawaan (kongenital) : o Disgenetik kelenjar tiroid: ektopik. . . o Ibu mendapat  Bahan goitrogen.Letargi. masa kehamilan > 40 minggu. . dan ”motling” (berbercak-bercak). dan pubertas. agenesis. tulang. Diagnosis dan pengobatan dini penting untuk mencegah mental yang permanen pada penderita. metabolisme rendah. Sebab-sebab hipotiroid : .Makroglosi. tiourasil. hypopituitarism GEJALA KLINIS Riwayat dan gejala pada neonatus dan bayi : . .  Pengobatan yodium radio-aktif. Gejala pada anak besar : . o Dishormonogenesis. infiltrative disease (sistinosis. histiositosis-X).Suhu rektal < 35. .Sukar minum. aplasi atau hipoplasi.Kulit kering. .Bradikardia (< 100/menit). . .Riwayat BAB pertama > 20 jam setelah lahir dan sembelit (< 1 kali/hari). . .). goitrogen materials (iodine.Kulit kering.Riwayat ikterus lebih dari 3 hari.Aktivitas berkurang.Sebab-sebab yang didapat (”acquired”): o Tiroiditis limfositik menahun. tiourasil.Intoleransi terhadap dingin.Tekanan darah rendah. .

2. Bila fasilitas untuk mengukur faal tiroid ada. When the facility to measure thyroid function there.pediatrik.php? page=html&hkategori=pdt&direktori=pdt&filepdf=0&pdf=&html=07110-buoi228. given as early as possible.htm PENATALAKSANAAN Hormon tiroid Obat pilihan adalah Sodium L-Thyroxine.com/isi03. Hipopituitarisme MANAGEMENT Thyroid hormone Drug of choice is L-Thyroxine Sodium. when there is clinical improvement. “Euthyroid sick syndrome”.o o o o o Tiroidektomi. diberikan sedini mungkin. 1. the dose can be increased gradually or at a dose of 100 + μg/m2/hari administration. . http://old. 1. and TSH which can vary depending on the etiology of hypothyroidism. histiositosis-X). it can be done therapeutic trial until the age of 3 years starting with a low dose in 2-3 weeks. Defisiensi yodium (gondok endemik). When the facility to measure thyroid function does not exist. T4. Penyakit infiltratif (sistinosis. diberikan dosis seperti tabel berikut : Umur Dosis µg/kg BB/hari 0-3 bulan 10-15 3-6 bulan 8-10 6-12 bulan 6-8 1-5 tahun 5-6 2-12 tahun 4-5 > 12 tahun 2-3 Kadar T4 dipertahankan di atas pertengahan nilai normal. given the dose as the following table: Umur Dosis µg/kg BB/hari 0-3 bulan 10-15 3-6 bulan 8-10 6-12 bulan 6-8 1-5 tahun 5-6 2-12 tahun 4-5 > 12 tahun 2-3 T4 levels maintained in the mid-normal values. Thyroxine dose adjustment based on clinical response of thyroid function tests T3.

php? page=html&hkategori=pdt&direktori=pdt&filepdf=0&pdf=&html=07110-buoi228. ed. dan TSH yang dapat berbeda tergantung dari etiologi hipotiroid.htm DAFTAR PUSTAKA 1. 1996 : 369-81. In : Lifshitz F. 2004 : 83-108. Bila fasilitas untuk mengukur faal tiroid tidak ada. Disorders of the Thyroid in the Newborn and Infant. Missouri: Elsevier Mosby. Pediatric Endocrinology. 2005 : 171-90. Thyroid Disorders in Children. Caplin N. 2002 : 161-82. 2. Pediatric Endocrinology. http://old. Fisher DA. Philadelphia : Lippincott Williams & Wilkins. dapat dilakukan therapeutic trial sampai usia 3 tahun dimulai dengan dosis rendah dalam 2-3 minggu. Fort PF. Rossi WC. Brown RS. 3. dosis dapat ditingkatkan bertahap atau dengan dosis pemberian + 100 μg/m2/hari. ed. . Philadelphia : Saunders. In: Moshang T. Alter CA. St Louis. ed.Thyroid Disorders in Infancy.pediatrik. In : Sperling MA. New York : Marcel Dekker.com/isi03. 4. Penyesuaian dosis tiroksin berdasarkan respon klinik dari uji fungsi tiroid T3. Disorders of the Thyroid Gland. Styne DM. bila ada perbaikan klinis. T4. In: Core Handbooks in Pediatrics – Pediatric Endocrinology.2. Pediatric Endocrinology – The Requisites in Pediatrics.